My question is to you or anyone who is practicing is that do you ever feel that you don’t have the entire clinical picture that the physician has to arrive at the right therapy or to intervene successfully? If so, how often does this happen? It would be frustrating if that happens often. I guess I don’t understand the role of the pharmacist. The way I am thinking is that if for a certain patient, the doctor diagnoses X condition and chooses a therapeutic plan, how can a pharmacist judge if that plan is appropriate without having the knowledge of the disease that a physician has learned through several years in training?
If the pharmacist has that knowledge, that’s like going through med school and pharmacy school. The way I am seeing is that if I am able to critique what a physician is doing, then I must have the same or more knowledge about what he is doing to adequately critique. That’s like being a physician itself. So far (end of P2) I haven’t learnt pathophysiology in detail in pharmacy school and when I look at med school material, I see how little I am learning about the disease states.When do you trust a treatment plan because of lack of appreciation of the entire picture (that physician has or he should) and when do you intervene? Or is the pharmacist in place to know the guidelines and catch any deviations? I am seeing as black and white and haven’t been on rotations to fully appreciate the details of how things work.
You spend four years of school learning all about medicine and drug therapy. When you graduate you will still feel like you barely know anything, but after a while you gain confidence and realize that you know quite a bit more than you realized. You must also understand that physicians are human beings too, and even the ones with a god complex are not right all of the time. Especially with CPOE, you will often see appropriate drugs order in an inappropriate way. It isn't uncommon for someone to pick an antibiotic, click on one of the available doses and frequencies, and send the order your way. As the pharmacist it would be your duty to ensure everything is appropriate. Maybe they ordered 40 mg/kg, but the patient's condition is acute and calls for 80 mg/kg. Maybe they ordered potassium phosphate in a 100 mL bag, but the patient is an infant in heart failure who cannot tolerate the fluid load, and there is plenty of room to concentrate the drug. Don't forget pharmacokinetics. In many institutions, the dosing and monitoring of vancomycin and aminoglycosides are the sole responsibility of the pharmacist.
Physicians and nurses have a lot of things to worry about; we have one thing. It will be your job to optimize drug therapy for your patients. Review their profiles and ensure there are indications for their drugs, search for therapeutic duplication, and catch the dangerous stuff that the one crazy pharmacist always puts through. In addition to this, you will be a resource for everyone in the hospital. Nurses will ask you about IV compatibility and infusion rates, especially for things like phenytoin or potassium which are infused at rates based on weight. Don't be surprised if you get calls from PAs and physicians just straight up asking you how to dose something, or sometimes asking for a recommendation of what drug to use.
I think I understand where you are coming from, because I became very cynical about pharmacy during my last year. It wasn't until I began practicing and gained confidence in myself that I realized how important our job is. We will never be the hero, as we are always working behind the scenes. What we do is in no way glamorous, although the trade off is that it is often less stressful than our fellows in nursing and medicine. However, every single day you are afforded the opportunity to improve the quality of care for your patients. Often it will be simple things like changing dosing, recommended therapeutic alternatives, or adjusting TPNs. Every once in a while you make an intervention that saves someone's life.
To follow up on your previous question, I'm a "clinical pharmacist", although we are all called that as every pharmacist as clinical duties even while staffing. To be honest, I feel like I do more good on my staffing days. That is when I am able to review the most patient profiles, and come across the most drug orders. On the clinical days I sort of just.. hang out in the unit. Honestly, I waste two hours on rounds acting as a drug reference when I could be doing other things. It's nice to bring up patient care issues as we go room to room, but I could handle all of that with a 10 minute conversation then get back to work.
